Research

Mixed

Higher appendicular skeletal muscle mass (ASMI) is independently associated with lower all-cause mortality, and accounting for muscle mass shifts the BMI associated with the lowest risk of death downward toward the normal range (22-25 kg/m2).

Do not rely on BMI alone to assess your health risk. If you have a 'normal' BMI but low muscle mass, your mortality risk may be higher than someone with a 'high' BMI but preserved muscle mass. Prioritize resistance training and protein intake to build or maintain skeletal muscle mass, as this is an independent protective factor against death, regardless of your weight.

GoodSupportsHIGH confidence
Higher ASMI was independently associated with a reduced risk of death (HR 0.82 per 1 kg/m2 (95% CI 0.73–0.92)). ... After accounting for muscle mass, the level of BMI associated with the greatest survival shifts downward toward the normal range.
Matthew K. Abramowitz et al. · PLoS ONE · 2018

Why this rating

Large, nationally representative cohort (NHANES, n=11,687) with objective DEXA body composition measurements and long-term mortality follow-up (median 9.3 years), though observational design limits causal inference.

Source

Muscle mass, BMI, and mortality among adults in the United States: A population-based cohort study

Matthew K. Abramowitz et al. · PLoS ONE · 2018

DOI 10.1371/journal.pone.0194697

cohort · n=11687Cited 228×
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DOI resolved against Crossref · corpus check 2026-06-10

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